St. Anthony’s Cancer Care Center

Cancer Care Annual Report - 2017

The mission, vision and valuates of St. Anthony’s Medical Center are vital statements that guide the conduct and decisions made by our leaders, physicians and employees. The mission describes what we do and have done for decades, and our vision expresses what we will be – for the patients we serve today and in the future.

Mission – St. Anthony’s, a Catholic medical center, has the duty and the privilege to provide the best care to every patient, every day.

Vision - Working as trusted partners, the physicians and employees of St. Anthony's Health System will deliver care distinguished by its demonstrated quality and personalized service. We will be visibly engaged in improving the health and well¬ being of the communities we serve in South County and beyond. We will stand together, proud to set the standard for independent community health systems.

  • The patient comes first in all we do.
  • We will strive for excellence through teamwork and mutual respect.
  • We express compassion and respect for all persons served and those serving.
  • As a Catholic medical center, we support the spiritual and physical needs of our patients and staff.

The Cancer Care Program at St. Anthony’s Medical Center has continued to grow in past many years. Cancer services at St. Anthony’s offers high quality, comprehensive, compassionate care for patients through education, screening, treatment and survivorship services.

We are very excited about affiliation between Mercy and St. Anthony’s Medical Center in St. Louis. The two organizations announced in February 2017 they were entering a definitive agreement for an affiliation, which became effective June 1. Under the terms, St. Anthony’s became Mercy’s fifth acute care hospital in the greater St. Louis region and the third largest hospital across Mercy’s four states.

Cancer Registry

Hospital-based cancer registries serve as the nation’s primary source of oncology statistics. The Cancer Registry’s comprehensive of patient data facilities comparisons among individual facilities and the state or the nation as a whole. As with all cancer registries, the role of the Cancer Registry at St. Anthony’s Medical Center continues to grow and evolve. With advances in cancer-related research, technology and treatments, the Cancer Registry collects more detailed information than ever before. Information is collected and analyzed from many aspects, including from demographics, personal and family histories, risk factors, diagnostic procedures, cancer site and histology, tumor markers, prognostic indicators, staging, treatment, follow-up and survival data for each patient.

The Cancer Registry provides information to the physicians, administrators and health care planners to provide coordination and support for cancer program development. Cancer data is important to many people for a variety of different reasons. It tracks quality of care and treatment by monitoring compliance with national, evidence-based guidelines. Cancer registry staff maintains and submits required documentation to ensure the cancer program complies all standards established by the Commission on Cancer (CoC) to maintain accreditation as a Community Cancer Program and ensure compliance with Missouri reporting standards.

In 2016, top five sites diagnosed and/or treated at SAMC were Lung (16.41%), Breast (16.02%), Prostate (8.63%), Colon (8.01%) and Melanoma of Skin (6.70%).

Top 5 Cancer Sites 2017
Top five sites diagnosed and/or treated at St. Anthony's in 2016

Top Five sites with Stage at diagnosis in 2016
Top five sites with stage at diagnosis in 2016

Low –Dose CT Lung Cancer Screening

St. Anthony’s Medical Center began offering Low-Dose CT Lung Cancer Screenings in January, 2016. These Low-Dose CTs of the chest are available to the high risk population for lung cancer. CT scans have been proven to be three times more effective in detecting lung cancer than a standard chest X-ray. The National Lung Screening Trial found a 20 percent reduction in deaths from lung cancer among current or former smokers who were screened with low-dose CT verses a standard X-Ray. This screening program is for current or former cigarette smokers between the ages of 55 to 77. They must have smoked one pack per day for 30 years, or two packs per day for 15 years. If a former smoker, they need to have quit within the last 15 years. In general, they should be in good health have no sign or symptoms of lung cancer.

Patients meet with a lung navigator prior to the scan to discuss the risk and benefits of screening. If the patient is a current smoker, the benefits of smoking cessation are discussed and a smoking educational folder is provided to them. If there are positive results the lung navigator will continue to follow the patient through the treatment process.

The patient receives a very low dose of radiation; much less than the average person receives from background radiation in six months.

The referring provider and patient receive the results of the screening. Those patients who have positive results are referred to cancer physicians for follow up care.

For the 287 screenings we have conducted, there were five positive screenings for lung cancer.

For further low-dose CT lung cancer screening information, Pam Lynn, MSN, RN, ANP-BC can be reached at 314-525-6095.

Performance Measures

The Commission on Cancer (CoC) requires accredited cancer programs to treat cancer patients according to nationally accepted quality improvement measures indicated by the CoC quality reporting tool, Cancer Program Practice Profile Reports (CP3R). The function of the quality improvement measure is to monitor the need for quality improvement or remediation of treatment provided. Accountability measures promote improvements in care delivery. The quality improvement measure function is to monitor the need for quality improvement. Surveillance measures generate information for decision making and/or monitor patterns and treads of care.

Cancer Program Practice Profile Reports (CP3R)
Review of Analytic Rectum, Colon, and Breast Cases Diagnosed 

 
 Title Measure Definition  CoC 
Std%
2013 2014 2015 2016 
 RECRT

  RECRTCT - Preoperative chemo and
  radiation are administered for clinical 
  AJCC T3N0, T4N0, or Stage III; or
  Postoperative chemo and radiation are
  administered within 180 days of 
  diagnosis for clinical AJCC T1-2N0
  with pathologic AJCC T3N0, T4N0, or
  Stage III; or treatment is recommended;
  for patients under the age of 80
  receiving resection for rectal cancer
 (Quality Improvement)

 4.5 / 85%  92.3%

 71.4%

(2 patients
started chemo
after surgery;
After measure
deadline)

87.5%  100% 
 12RLN   12RLN - At least 12 regional lymph
  nodes are removed and pathologically
  examined for resected colon cancer
  (Quality Improvement) 

 4.5 / 85%  94.7%   93.4%  95.7%   85%
 ACT

  Adjuvant chemotherapy is 
  recommended or administered within 4
  months (120 days) or diagnosis for
  patients under the age of 80 with AJCC
  stage III (lymph node positive) colon
  cancer (Accountability)

 4.4 / 90%   100%  92.9%  81.3%  100%
 BCSRT   BCSRT - Radiation is administered
  within 1 year (365 days) of diagnosis
  for women under the age of 70 receiving
  breast conservation surgery for breast
  cancer (Accountability)
 4.4 / 90%  100%  100%  94.6%

 84%

(4 patents
refused
XRT)

 

 HT

  HT - Tamoxifen or third generation 
  aromatase inhibitor is recommended or
  administered within 1 year (365 days) of 
  diagnosis for women with AJCC T1c or
  stage 1B-III hormone receptor positive 
  breast cancer (Accountability)

 4.4 / 90%  98.7%  96.8%  98.2%  
 MASTRT 

  MASTRT - Radiation therapy is 
  recommended or administered following
  any mastectomy within 1 year (365
  days) of diagnosis of breast cancer for 
  women with >= 4 positive regional
  lymph nodes (Accountability)

 4.4 / 90% 100%  100% 100%  100%
 MAC   MAC - Combination chemotherapy is
  recommended or administered within 4
  months (120 days) of diagnosis for
  women under 70 with AJCC T1cN0, or
  stage 1B - III hormone receptor negative
  breast cancer (Accountability) 
 NA  100%  100%  100%  100%
 BCS   BCS - Breast conservation surgery rate
  for women with AJCC clinical stage 0, I
  or II breast cancer (Surveillance)
 NA  52.6%  63.8%  57.9%  57.3%
nBx   nBx - Image or palaption-guided needle
  biopsy to the primary site is performed
  to establish diagnosis of breast cancer
  (Quality Improvement)
 4.5 / 80%  93.2%  94.9%  93.9%  91.4%

 

 

Cancer Conferences

Cancer Registry monitors cancer conference activity to ensures that conference provide consultative services for patients to formulate an effective treatment plan and offer education to physicians and allied health professionals in attendance. Monitoring of cancer conference activity may also identify opportunities to improve the patient care process.

Cancer Conferences held in 2016

Meetings   Attendance  Cases
Quarters # Cancer
Conferences
each Quarter

Medical
Oncology
Average %
Attendance
each Quarter

Radiation
Oncology
Average %
Attendance
each Quarter

Surgery
Average %
Attendance
each Quarter

Pathology
Average %
Attendance
each Quarter

Diagnostic
Radiology
Average %
Attendance
each Quarter

# Cases
Presented
each
Quarter 
# Prospective
Cases each
Quarter
% Cases
Presented 
Prospectively
each Quarter 

# Stagable
Cases
each
Quarter

# Cases
with Stage
Given each
Quarter

% of
Cases
Staged
each 
Quarter 

# Clinical
Trials
Discussed 

Q1 17 100% 100% 100% 100% 100% 86 86 100% 74 73 99%  3
Q2 19 100% 100% 89% 100% 100% 85 84 99% 73 73 100%  2
Q3 15 100% 100% 80% 100% 100% 82 81 99% 68 67 99%  6
Q4 17 100% 100% 82% 100% 94% 82 81 99% 68 68 100%  1
     
  Total #
Cancer
Conferences
Med Onc
Average %
Attendance 
Rad Onc 
Average %
Attendance
Surgeon
Average %
Attendance
Pathologist
Average %
Attendance
Diag Rad
Average %
Attendance 
Total # of 
Cases
Presented
Total # of
Prospective 
Cases
% Cases
Presented
Prospectively
Total # of 
Stagable
Cases
Total # of 
Cases 
Staged

% of
Cases 
Staged

 #
Clinical
Trials
Discussed
Annual
Totals
68 100% 100% 88% 100% 99% 335 332 99% 283 281 99%  12

 

Cancer Care Committee Members: 2017

Cancer Committee Members – SAMC is composed of physicians from varying specialties and other health care professionals active in oncology services.

Cancer Committee Members

Dr. Mary Graham
Radiation Oncologist 
Cancer Committee Chair

Dr. Paul Oberle
Diagnostic Radiologist 
Dr. Kirke Bieneman
Interventional Radiologist
Dr. Kiran Chunduri
Interventional Radiologist
Dr. Emily Popovic
Pathologist

Dr. Heather Wright
Pathologist

Dr. Steven E. West
Surgeon, ENT specialist
Surgery
Dr. Sarah Snell
Surgeon
Breast specialist 
Dr. Craig Hildreth
Medical Oncologist
Dr. Stephen Allen
Medical Oncologist
Dr. Mary Graham
Radiation Oncologist
Dr. Jenny Shaffer
Radiation Oncologist
Dr. Anitha Rayani
Hospitalist
Cancer Liaison Physician
Dr. William Morris
Medical Oncologist
Calvin Robinson
Cancer Program Administrator
Bill Hoefer
Chief Operating Officer
Sarah Kort, RN
Oncology Nurse
Marie Graham, RN, ONC
Oncology Nurse
Kathleen Dooling
Social Worker
Mary Ann Winkler, RN
Social Worker
Sabina Lall, CTR
Certified Tumore Registrar
Dr. Edward Burns
Palliative Care
Shari Mareschal
Director of Palliative Care Services
Wendy Forys, RN, MSN
Quality Improvement Coordinator
 
Sabina Lall, CTR
Cancer Registry Quality Coordinator
 
Laura Bub, MPH
Community Benefit Manager
Katie Rayfield
Coordinator, Community Outreach
Janet Lesko, RN
Clinical Research Coordinator
Sara Gibson, PharmD
Pharmacy Operations Manager
Grace Marting, MSW
Psychosocial Services Coordinator
Argentina "Tina" Baldridge
Social Worker

 

Cancer Prevention Events in 2016

March – Colorectal cancer prevention - “Follow your Gut – Ask the Gastroenterologist”. Colorectal cancer is the third most diagnosed cancer and the third leading national cause of cancer death. Only 34 percent of all colorectal cancer is diagnosed in the early stage in St. Louis County. Cancers of the colon was the 5th most diagnosed and treated type of cancer at St. Anthony’s Medical Center in 2013. Participants at this informative lecture were given the recommendations for their screenings needed based on their age and family history (if provided).

May – Skin Cancer Screening: Melanoma is on the rise nationally, as well as in the St. Louis region. Skin cancer rates (excluding basal and squamous) in the St. Louis region for men rose from 163 per 100,000 people in 1996 to 347 in the year 2010 and from 275 for women in 1996 to 589 in 2010. St. Anthony’s has also experienced a rise in melanoma cases. Melanoma was ranked 3rd in the top sites diagnosed at St. Anthony’s in 2013 and was 8.41 percent of all cancer cases. Diagnosing melanoma at an early stage can lead to favorable outcomes. 82 members of our community were screened for skin cancer that they might not have otherwise obtained. Recommendations for improvement: Follow up with patients 2-3 months later to determine if they obtained the follow up appointments needed.

September - St. Anthony’s hosted an event at Ronnie’s 20 Cine to watch Field of Dreams and help the community learn about how to strike out the most prevalent types of cancers affecting our area. Before the show, attendees were given the chance to learn about cancer prevention and treatment at our various education booths and participate in interactive activities.

October - Paint the Mall Pink” at South County Mall during breast cancer awareness month. St. Anthony’s Medical Center painted the mall pink for the month of October to create awareness of breast cancer and the importance of women getting their annual mammograms. This month long awareness campaign kicked off with a booth staffed by our Breast Care team that focuses on providing breast care prevention information to shoppers. St. Anthony's employees handed out early detection breast cancer cards at all entrances of the mall.

November – Lung Cancer Awareness Event at South County Mall during Lung Cancer Awareness Month. Educational booth with spirometry tests, including an interactive exhibit focused on lung health, prevention and lung cancer screenings. Free spirometry tests were available to all participants.

Healthy Lifestyle Program - Newtritious You. Three different course offerings (each 7 week programs) – January through March 2016, May through June, 2016 and September through October, 2016. As part of St. Anthony’s commitment to the health and wellness of the community, Newtritious You – a free, seven week, in-depth wellness, and nutrition and lifestyle program is offered free of charge. This program is taught by dietitians, physical therapists and social workers and is utilized as a preventative program for healthy lifestyle and to prevent chronic diseases and conditions.

 

Monitoring Compliance with Evidence-Based Guidelines, Standard 4.6

In 2016, Dr. Lodato, Pathologist, performed evidence based study of Breast Cancer recommend that Clinical Stages I, IIA, IIB, and IIIA (T3 N1 M0) patients should undergo axillary lymph node staging. The guidelines further state that Sentinel Lymph Node Biopsy (SLNB) should be performed and is the preferred method of axillary node staging if the patient is an appropriate SLNB candidate. Patients with pre-op positive nodes on FNA or core biopsy get Axillary Lymph Node Dissection (ALND).

Data Collection: Breast cancers diagnosed and/or surgically staged at SAMC between January 1 and June 30, 2015, were be retrieved from both the Tumor Registry and Pathology department files, and records for those with clinical stages I, IIA-B, and IIIA-T3N1M0 were be reviewed. Axillary node sampling and whether or not sentinel node technique was used was documented.

Results: Only one of 73 cancers in patients who were clinically appropriate candidates did not undergo SLNB: 8.6 percent compliance with NCCN guidelines. 21 of 91 patients with newly diagnosed breast cancer on biopsies at St. Anthony's during this period went elsewhere for their follow-up cancer care (23 percent).

Quality studies, Standard 4.7The annual evaluation of the care of cancer patients provides a baseline to measure quality and an opportunity to correct or enhance care and quality outcomes. Quality improvement efforts focus on evaluating areas of cancer care and must include multidisciplinary representation from clinical, administrative, and patient prospective.

In 2016, the following studies were completed and evaluated by cancer committee:

  • Study comparing diagnostic accuracy of lung biopsy techniques
  • Study placement accuracy of port-a-catheter insertions.

Quality Improvements, Standard 4.8Quality or performance improvements are the actions taken, process implemented, or services created to improve cancer care. Implementation of improvements demonstrates a programs continuous commitment to providing high-quality patient care. The results of a cancer-related quality study provide a baseline to measure and improve quality.

In 2016, the following improvements were completed and evaluated by cancer committee:

  • To improve the QA of IMRT & VMAT treatment plans & delivery using Mobius FX replacing the portal dosimetry.
  • Enhance screening process to identify cancer patients needing financial counseling and/or assistance.

 

Clinical Research

Clinical trials offer cancer patients new hope for successful treatment options. Research is an integral part of care at the St. Anthony’s Medical Cancer Center. We are dedicated to providing a variety of treatment opportunities to patients that are interested in participating in research studies.

St. Anthony’s Oncology Research Department provides clinical and administrative support for clinical trials sponsored by the Nation Cancer Institute, Alliance for Clinical Trials in Oncology as an affiliate site to Washington University, St. Louis, Missouri. Dr. Michael (Minxiang) Gu is our Principal Investigator supported by six NCI Investigators.

  • 17 National Cancer Institute (NCI) Sponsored Cooperative Group Clinical Trials
  • Recognized as a “Signatory Institution” with the NCI Central Institutional Review Board (CIRB) for oncology research trials
  • Seven research studies open to new patient registration
  • Multi-site Research Trials: four breast, one head/neck, one neuro/glioblastoma, and one multi-site (any type solid tumor or lymphoma).
  • NCI Match Trial Phase II clinical trial targeting certain genetic changes and matches patients to more than 20 treatment sub-studies

 

2017 Cancer Committee

St. Anthony’s Medical Center 2017 Cancer Committee is a multi-specialty committee that includes board certified doctors, members of administration, nursing, social services, radiology, quality assurance, cancer registry, and other related specialty staff. The chair for 2017 is Mary Graham, MD radiation oncology and NCI Investigator joined by Michael (Minxiang) Gu, MD, oncologist, PI-Principal Investigator, & CLP-Cancer Liaison Physician. Our cancer research program has been recognized with commendation for exceeding the expectations of clinical trials accruals as a Community Hospital Comprehensive Cancer Program.

Cancer related trial information is available throughout the Medical Center, Medical Plaza, Cancer Center, Out Patient Infusion, Breast Center, and in the offices of our medical oncologists. Clinical Trial Information is available via the internet on the St. Anthony’s Medical Center webpage under More About “The Cancer Center” 2) Cancer Patient Services 3) Cancer Trials & Research with a direct link to the Open Research Trials. The American Cancer Society also provides patient referrals to a 1-800 number for national clinical trial information which includes St. Anthony’s list of oncology trial availability.

 

Survivorship Care Plan

Survivorship can mean different things to different people, but often it describes the process of living with, through and beyond cancer. Transitioning from active treatment into post-treatment care is critical to optimal long-term health. Completing treatment is just the beginning for cancer survivors. They may experience side effects caused by their surgery, chemotherapy and radiation treatments. To help our cancer survivors a survivorship program was launched with supports patient and their families along the continuum of care making them aware of follow up care and health loving beyond caner. In 2016, 217 cancer survivors received a Survivorship Care Plan and Treatment Summary at St. Anthony’s Medical Center.

Upon completion of treatment, the information reviewed with the survivorship nurse practitioner, Heather AGNP-BC, or with a member of the multidisciplinary cancer care team. The survivorship care plan with include a treatment summary and serve as a resource for the patient to help him or her monitor and develop a healthy lifestyle. Explanation of the survivorship care plan will include discussion of possible early and late treatment side effect and reviewing health maintenance recommendation by the National Comprehensive Cancer Network (NCCN).

During the survivorship care plan visit, patients are provided with recommendations for follow up test, nutrition tips, management of physical changes, emotional health, and cancer support groups. A copy of the Survivorship Care Plan and Treatment Summary will be provided to the patient and sent to the primary care provider, referring providers and those providers requested by the patient. The program goal is to return patient to their pre-treatment lives and activities.

For further cancer survivorship information, Heather Girard, MSN.AGNP-BC can be reached at 314-525-6091.

 

Support Services, Programs & Community Partners for cancer care patients

A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Patients’ navigators provide personalized guidance, support and assistance to patients and their families. Patient navigator role helps in connecting patients and families to resources and supportive care staff and services. We provide the following support services at St. Anthony's and are community partners with for cancer care patients:

Nurse Navigators

  • Breast Care Navigator
  • Lung Navigator
  • Survivorship Coordinator

Oncology Social Work

Oncology Dietitians

Charitable Foundation Grants

  • Transportation Assistance Grant
  • Individual Support Program
  • Art Therapy Grant

Support Groups

  • Breast Cancer Support Group
  • Prostate Cancer Support Group
  • All Cancer Support Group

American Cancer Society

  • Look Good Feel Better
  • Road to Recovery
  • Reach to Recovery
  • Personal Health Managers
  • Free Wigs
  • Making Strides Against Breast Cancer Walk

Cancer Support Community

  • Frankly Speaking about Coping with the Cost of Care
  • Frankly Speaking about Cancer Treatment and Side Effects

Colon Cancer Alliance Undy Run

Free to Breathe Lung Cancer Walk

 

Radiation Oncology

Stereotactic Radiosurgery (SRS) is precisely targeted radiation treatment used to treat intracranial tumors and other less common neurological diseases.  Radiosurgery does not involve surgery, but is the delivery of a dose of radiation with the precision of surgery.  Treatment is highly precise and painless.  Treatment is given on an outpatient basis on a specialized radio therapeutic linear accelerator.  Because there is no surgical incision, patients are able to go home the same day and return to their usual activities within 24 hours.  SRS procedures are administered by a team of physicians including a radiation oncologist, neurosurgeon and medical physicist.  

Stereotactic Body Radiotherapy (SBRT) is precisely-targeted radiation treatment used to treat tumors in the lung, liver, pancreas, spine, pelvis, bone, and adrenal gland.  Treatment is precise, painless and takes only one to five treatment sessions as compared to several weeks for traditional radiation therapy.  SBRT is a non-invasive, outpatient procedure.  Because there is no surgical incision, patients are able to return to their usual activities immediately.  

At St. Anthony’s, we utilize Align RT to accurately monitor the patient during SRS/SBRT treatments.  Patient positioning is within millimeter precision to assure correct radiation delivery.  The treatment machine can be gaited to stop treatment if movement is out of the programmed threshold levels.  Align RT is beneficial because the patient can be monitored without additional radiation being delivered.

The idea tumor for SRS/SBRT is relatively small with well-circumscribed boarders that are accurately imaged by MRI or CT.  SRS/SBRT is ideal for specific tumors, including brain, lung, liver and spine.  

Outpatient Infusion Center

* Preparation. All chemotherapy medications are prepared on site at each location.  Every step of the process, from selection of the drug, to measurement, to compounding, is captured using bar code technology for verification by a pharmacist prior to dispensing the medication. Only then is the chemotherapy sent to a nurse to be administered to the patient.

* Administration. Patient safety is paramount and proper administration of chemotherapy requires very strict protocols. We operate under the guidelines of the Oncology Nursing Society for the administration of all chemotherapy. All nurses have completed chemotherapy certification training.

*A social worker is available at the cancer center to provide counseling and assist with applications for financial resources, transportation, housing and accessing community resources. Patients may self-refer to this program, or their physicians may refer them to specific therapies, based on their needs.

Fully Accredited

St. Anthony’s Medical Center is fully accredited by Commission on Cancer (CoC). CoC accreditation is granted to facilities that are committed to providing the best in cancer care and demonstrate with CoC Eligibility Requirements and Standards. We earned three-year accreditation from the Commission on Cancer of the American College of Surgeons. We are also accredited by the American Society for Radiation Oncology (ASTRO) for our Radiation Oncology Program. St. Anthony's demonstrated compliance with a majority of the program standards and has been awarded full accreditation by the ASTRO Accreditation Program for Excellence.